The incidence of fungal nail infections is increasing and this is possibly
because of several factors: better methods of detection, a growing populati
on of immunocompromised patients who have a greater susceptibility to such
infections, the increased use of immunosuppressive drugs, the increasing nu
mber of elderly people, worldwide travel, and the use of communal bathing f
acilities. Onychomycosis is a fungal infection of the fingernails and toena
ils that accounts for about 30% of all superficial fungal infections. It is
characterised by nail discoloration, thickening and ultimately destruction
of the nail plate. Management of this disease has improved significantly a
nd treatment patterns have dramatically changed in recent years as a result
of advances in new treatment options (e.g. oral antifungal agents) and cha
nges in treatment regimens (e.g. pulse therapy). Also, newer drugs for onyc
homycosis have improved tolerability profiles compared with older agents. T
he overall costs of treating onychomycosis are substantial, and it has been
estimated that direct cost for US Medicare patients with the disease is $U
S43 million per year (year of costing not available).
Pharmacoeconomic studies help in the decision-making process when selecting
the most cost-effective antifungal agents to treat onychomycosis. To date
there have been a number of national and international economic studies aim
ed at effectively assessing the efficacy and costs of the treatment options
available to cure onychomycosis. The objectives of this paper are to (i) r
eview the published findings regarding the epidemiology of onychomycosis (i
i) summarise the original pharmacoeconomic studies that describe the econom
ic impact of the disease; and (iii) address the impact of the disease on pa
tients' health-related quality of life.